Lateral supramalleolar flap for heel coverage in a patient with Werner's syndrome

The repair of intractable ulcer over the Achilles' tendon in a patient with Werner's syndrome is described. The ulcer was covered successfully with a lateral supramalleolar flap combined with a delay procedure. Partial necrosis of the flap occurred; however, the necrotic area could be repaired with a skin graft because the underlying adipofascia of the flap survived. Histopathological studies revealed marked dermal fibrosis spreading to the subcutis, however the deep adipofascia was not so afflicted. The lateral supramalleolar flap, if combined with a delay procedure, can be used as a first choice in the repair of an ulcer in the heel region as long as apparent arteriosclerotic changes do not exist.